Breast Health

Women in Their 40s Need Annual Mammogram

The American College of Obstetricians and Gynecologists (ACOG) has released new guidelines for mammography that call for annual mammograms for all women, beginning at age 40.

The new guidelines differ from the group's previous recommendation of a mammogram once every two years.

The advice also conflicts with that of the U.S Preventive Services Task Force, which changed its recommendation in 2009 to once every two years, beginning at age 50.

'Sojourn time'

According to ACOG, more than 207,000 American women were diagnosed with invasive breast cancer in 2010, and nearly 40,000 died from it. Breast cancer is the second most common type of cancer among women in the U.S. after skin cancer. It may be detected by a mammogram before it grows big enough to cause symptoms - a period know as the "sojourn time."

A key factor in the ACOG recommendation is the shorter sojourn time among younger women. Women ages 40 to 49 have a sojourn time of 2 to 2.4 years, the guidelines said, while those ages 50 to 59 have a sojourn time of 2.5 to 3.7 years, and women 70 to 74 have a sojourn time of 4 to 4.1 years.

"In these younger patients, we have a smaller window because these cancers tend to grow faster, sooner," says Lauren Cassell, M.D., at Lenox Hill Hospital in New York City. "There are plenty of patients who develop breast cancer between 40 and 50. The fear was we would miss these younger patients and see them at later stages."

Other recommendations

The American Cancer Society's and the National Comprehensive Cancer Network's screening recommendations are identical to ACOG's new guidelines. The National Cancer Institute (NCI) recommends mammograms every one to two years, beginning at age 40.

The American College of Radiology and the Society of Breast Imaging support the updated ACOG recommendations. These two groups based their decision on data from the NCI that show the U.S. breast cancer death rate - previously unchanged for 50 years - dropped 37 percent since mammograms became widespread in the 1990s.

"This is all based on our best judgment with the best available evidence," says Jennifer Griffin, M.D., at the University of Nebraska Medical Center and co-author of the ACOG guidelines. "Women in their 40s typically have children, some have elderly parents; many are active in the workforce. I don't think we can really underestimate the value of that one life saved."

Online Resources

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September 2011

Keep These Mammography Tips in Mind

Certain factors or conditions may interfere with a mammogram:

Talcum powder, deodorant, creams, or lotions applied under the arms or on the breasts.

Breast implants, because they may prevent complete visualization of the breast. If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment. You will need an X-ray technologist who is trained in working with patients with implants. This is important because breast implants can hide some breast tissue, which could make it difficult for the radiologist to see breast cancer when looking at your mammogram images.

Previous breast surgery.

Hormonal breast changes.

Age. Mammograms may be more difficult to interpret in women younger than 30 years old because of the increased density of their breast tissue.

Always talk with your health care provider to find out more information.